1887

Abstract

Purpose. We assessed the prevalence and predictors of Chlamydia trachomatis, Neisseriagonorrhoeae and Mycoplasmagenitalium rectal infections in a population of ‘men having sex with men’ (MSM).

Methodology. From January to November 2017, 165 MSM attending a STI outpatients clinic in Bologna (Italy) and reporting unsafe anal intercourses were enrolled. An ano-rectal swab was collected from each patient: chlamydial and gonococcal infections were diagnosed by a commercial NAAT, whereas an in-house quantitative PCR was used for M. genitalium detection. In addition, 131 urine samples and 84 pharyngeal swabs underwent testing for C. trachomatis and N. gonorrhoeae. A molecular C. trachomatis typing, a serological screening for anti-Chlamydia IgG and IgA, as well as the assessment of HIV, HCV and syphilis infections, were performed.

Results/Key findings. The prevalence of C. trachomatis, N. gonorrhoeae and M. genitalium rectal infections was 27.2, 25.4 and 4.8 %, respectively. Globally, 63.1 % of cases were asymptomatic and up to 80 % of chlamydial and gonococcal infections would have been missed if the rectal site had not been tested. All the patients with rectal M. genitalium carriage were asymptomatic and characterized by low bacterial loads (<2500 DNA copies/reaction). Lymphogranuloma venereum (LGV) prevalence was 12.1 % with a considerable proportion of asymptomatic infections (35 %). The presence of symptoms, age >30, HIV-positivity and elevated levels of anti-Chlamydia antibodies were the most significant predictors of LGV.

Conclusions. Sexually transmitted rectal infections are frequent and often asymptomatic among MSM. LGV prevalence is high in our country and there is increasing evidence of symptomless cases.

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2018-06-21
2019-09-15
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References

  1. Davis TW, Goldstone SE. Sexually transmitted infections as a cause of proctitis in men who have sex with men. Dis Colon Rectum 2009;52:507–512 [CrossRef][PubMed]
    [Google Scholar]
  2. Workowski KA, Bolan GA. Centers for disease control and prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64:1–137
    [Google Scholar]
  3. Allan-Blitz LT, Leon SR, Bristow CC, Konda KA, Vargas SK et al. High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2017;28:138–144 [CrossRef][PubMed]
    [Google Scholar]
  4. Danby CS, Cosentino LA, Rabe LK, Priest CL, Damare KC et al. Patterns of extragenital chlamydia and gonorrhea in women and men who have sex with men reporting a history of receptive anal intercourse. Sex Transm Dis 2016;43:105–109 [CrossRef][PubMed]
    [Google Scholar]
  5. Tao G, Hoover KW, Nye MB, Peters P, Gift TL et al. Rectal Infection With Neisseria gonorrhoeae and Chlamydia trachomatis in men in the United States. Clin Infect Dis 2016;63:1325–1331 [CrossRef][PubMed]
    [Google Scholar]
  6. Barbee LA, Khosropour CM, Dombrowksi JC, Golden MR. New human immunodeficiency virus diagnosis independently associated with rectal gonorrhea and chlamydia in men who have sex with men. Sex Transm Dis 2017;44:385–389 [CrossRef][PubMed]
    [Google Scholar]
  7. Soni S, Alexander S, Verlander N, Saunders P, Richardson D et al. The prevalence of urethral and rectal Mycoplasma genitalium and its associations in men who have sex with men attending a genitourinary medicine clinic. Sex Transm Infect 2010;86:21–24 [CrossRef][PubMed]
    [Google Scholar]
  8. Reinton N, Moi H, Olsen AO, Zarabyan N, Bjerner J et al. Anatomic distribution of Neisseria gonorrhoeae, Chlamydia trachomatis and Mycoplasma genitalium infections in men who have sex with men. Sex Health 2013;10:199–203 [CrossRef][PubMed]
    [Google Scholar]
  9. Zheng BJ, Yin YP, Han Y, Shi MQ, Jiang N et al. The prevalence of urethral and rectal Mycoplasma genitalium among men who have sex with men in China, a cross-sectional study. BMC Public Health 2014;14:195 [CrossRef][PubMed]
    [Google Scholar]
  10. Bissessor M, Tabrizi SN, Bradshaw CS, Fairley CK, Hocking JS et al. The contribution of Mycoplasma genitalium to the aetiology of sexually acquired infectious proctitis in men who have sex with men. Clin Microbiol Infect 2016;22:260–265 [CrossRef][PubMed]
    [Google Scholar]
  11. Lutz AR. Screening for asymptomatic extragenital gonorrhea and chlamydia in men who have sex with men: significance, recommendations, and options for overcoming barriers to testing. LGBT Health 2015;2:27–34 [CrossRef][PubMed]
    [Google Scholar]
  12. Grov C, Cain D, Rendina HJ, Ventuneac A, Parsons JT. Characteristics associated with urethral and rectal gonorrhea and chlamydia diagnoses in a us national sample of gay and bisexual men: results from the one thousand strong panel. Sex Transm Dis 2016;43:165–171 [CrossRef][PubMed]
    [Google Scholar]
  13. de Vrieze NH, de Vries HJ. Lymphogranuloma venereum among men who have sex with men. An epidemiological and clinical review. Expert Rev Anti Infect Ther 2014;12:697–704 [CrossRef][PubMed]
    [Google Scholar]
  14. Foschi C, Marangoni A, D'Antuono A, Nardini P, Compri M et al. Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy. BMC Res Notes 2014;7:225 [CrossRef][PubMed]
    [Google Scholar]
  15. Bachmann LH, Johnson RE, Cheng H, Markowitz L, Papp JR et al. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis rectal infections. J Clin Microbiol 2010;48:1827–1832 [CrossRef][PubMed]
    [Google Scholar]
  16. Cornelisse VJ, Chow EP, Huffam S, Fairley CK, Bissessor M et al. Increased detection of pharyngeal and rectal gonorrhea in men who have sex with men after transition from culture to nucleic acid amplification testing. Sex Transm Dis 2017;44:114–117 [CrossRef][PubMed]
    [Google Scholar]
  17. Patton ME, Kidd S, Llata E, Stenger M, Braxton J et al. Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men–STD Surveillance Network, United States, 2010–2012. Clin Infect Dis 2014;58:1564–1570 [CrossRef][PubMed]
    [Google Scholar]
  18. Horner PJ, Martin DH. Mycoplasma genitalium infection in men. J Infect Dis 2017;216:S396–S405 [CrossRef][PubMed]
    [Google Scholar]
  19. Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 1995;8:1–21[PubMed]
    [Google Scholar]
  20. Marangoni A, Foschi C, Nardini P, Compri M, Cevenini R. Evaluation of the versant CT/GC DNA 1.0 assay (kPCR) for the detection of extra-genital Chlamydia trachomatis and Neisseria gonorrhoeae infections. PLoS One 2015;10:e0120979 [CrossRef][PubMed]
    [Google Scholar]
  21. Bissessor M, Whiley DM, Fairley CK, Bradshaw CS, Lee DM et al. Persistence of Neisseria gonorrhoeae DNA following treatment for pharyngeal and rectal gonorrhea is influenced by antibiotic susceptibility and reinfection. Clin Infect Dis 2015;60:557–563 [CrossRef][PubMed]
    [Google Scholar]
  22. Foschi C, Nardini P, Banzola N, D'Antuono A, Compri M et al. Chlamydia trachomatis infection prevalence and serovar distribution in a high-density urban area in the north of Italy. J Med Microbiol 2016;65:510–520 [CrossRef][PubMed]
    [Google Scholar]
  23. Sayada C, Denamur E, Orfila J, Catalan F, Elion J. Rapid genotyping of the Chlamydia trachomatis major outer membrane protein by the polymerase chain reaction. FEMS Microbiol Lett 1991;67:73–78[PubMed]
    [Google Scholar]
  24. Chalker VJ, Jordan K, Ali T, Ison C. Real-time PCR detection of the mg219 gene of unknown function of Mycoplasma genitalium in men with and without non-gonococcal urethritis and their female partners in England. J Med Microbiol 2009;58:895–899 [CrossRef][PubMed]
    [Google Scholar]
  25. Foschi C, Salvo M, D'Antuono A, Gaspari V, Banzola N et al. Distribution of genital Mollicutes in the vaginal ecosystem of women with different clinical conditions. New Microbiol 2018;41:
    [Google Scholar]
  26. Chan PA, Robinette A, Montgomery M, Almonte A, Cu-Uvin S et al. Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature. Infect Dis Obstet Gynecol 2016;2016:1–17 [CrossRef][PubMed]
    [Google Scholar]
  27. Ramadhani HO, Liu H, Nowak RG, Crowell TA, Ndomb T et al. Sexual partner characteristics and incident rectal Neisseria gonorrhoeae and Chlamydia trachomatis infections among gay men and other men who have sex with men (MSM): a prospective cohort in Abuja and Lagos, Nigeria. Sex Transm Infect 2017;93:348–355 [CrossRef][PubMed]
    [Google Scholar]
  28. van Liere GA, Hoebe CJ, Niekamp AM, Koedijk FD, Dukers-Muijrers NH. Standard symptom- and sexual history-based testing misses anorectal Chlamydia trachomatis and neisseria gonorrhoeae infections in swingers and men who have sex with men. Sex Transm Dis 2013;40:285–289 [CrossRef][PubMed]
    [Google Scholar]
  29. Bissessor M, Fairley CK, Read T, Denham I, Bradshaw C et al. The etiology of infectious proctitis in men who have sex with men differs according to HIV status. Sex Transm Dis 2013;40:768–770 [CrossRef][PubMed]
    [Google Scholar]
  30. Bissessor M, Tabrizi SN, Fairley CK, Danielewski J, Whitton B et al. Differing Neisseria gonorrhoeae bacterial loads in the pharynx and rectum in men who have sex with men: implications for gonococcal detection, transmission, and control. J Clin Microbiol 2011;49:4304–4306 [CrossRef][PubMed]
    [Google Scholar]
  31. Bradshaw CS, Fairley CK, Lister NA, Chen SJ, Garland SM et al. Mycoplasma genitalium in men who have sex with men at male-only saunas. Sex Transm Infect 2009;85:432–435 [CrossRef][PubMed]
    [Google Scholar]
  32. Jensen JS, Cusini M, Gomberg M, Moi H. 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2016;30:1650–1656 [CrossRef][PubMed]
    [Google Scholar]
  33. European Centre for Disease Prevention and Control Annual Epidemiological Report 2015 – Lymphogranuloma venereum Stockholm: ECDC; 2017; Available fromhttps://ecdc.europa.eu/en/publications-data/lymphogranuloma-venereum-annual-epidemiological-report-2015
    [Google Scholar]
  34. Mohrmann G, Noah C, Sabranski M, Sahly H, Stellbrink HJ. Ongoing epidemic of lymphogranuloma venereum in HIV-positive men who have sex with men: how symptoms should guide treatment. J Int AIDS Soc 2014;17:19657 [CrossRef][PubMed]
    [Google Scholar]
  35. Benardon S, Lunghi G, Bono P, Orlandi A, Pacela F et al. LGV Chlamydia trachomatis serotypes: an update from Milan, Italy. Sex Transm Infect 2017;93:395 [CrossRef][PubMed]
    [Google Scholar]
  36. Stoner BP, Cohen SE. Lymphogranuloma Venereum 2015: clinical presentation, diagnosis, and treatment. Clin Infect Dis 2015;61:S865–S873 [CrossRef][PubMed]
    [Google Scholar]
  37. Saxon C, Hughes G, Ison C.UK LGV Case-Finding Group Asymptomatic lymphogranuloma venereum in men who have sex with men, United Kingdom. Emerg Infect Dis 2016;22:112–116 [CrossRef][PubMed]
    [Google Scholar]
  38. Association of Public Health Laboratories Laboratory Diagnostic Testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Expert Consultation Meeting Summary Report; January 13–15, 2009; Atlanta, GA Silver Spring, MD: Association of Public Health Laboratories; 2009; Available fromwww.aphl.org/aphlprograms/infectious/std/documents/ctgclabguidelinesmeetingreport.pdf
    [Google Scholar]
  39. Martin-Iguacel R, Llibre JM, Nielsen H, Heras E, Matas L et al. Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries. Eur J Clin Microbiol Infect Dis 2010;29:917–925 [CrossRef][PubMed]
    [Google Scholar]
  40. Van der Bij AK, Spaargaren J, Morré SA, Fennema HS, Mindel A et al. Diagnostic and clinical implications of anorectal lymphogranuloma venereum in men who have sex with men: a retrospective case-control study. Clin Infect Dis 2006;42:186–194 [CrossRef][PubMed]
    [Google Scholar]
  41. Rönn MM, Ward H. The association between lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis. BMC Infect Dis 2011;11:70 [CrossRef][PubMed]
    [Google Scholar]
  42. Unemo M, Bradshaw CS, Hocking JS, de Vries HJC, Francis SC et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis 2017;17:e235-e279 [CrossRef][PubMed]
    [Google Scholar]
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